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General NPI Number Information
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NPI Number | 1871501023
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Entity Type | Organization
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Legal Business Name | PAIN CLINIC PA RICHARD K. HURLEY MD
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 405 LONDONDERRY DR SUITE #311
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City | WACO
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State | TX
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Zip | 76712-7922
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Country | US
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Telephone | 254-235-4414
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Fax | 254-235-7378
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Provider Business Mailing Address
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Address Line | 405 LONDONDERRY SUITE #311
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City | WACO
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State | TX
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Zip | 76712-7922
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Country | US
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Telephone | 254-235-4414
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Fax | 254-235-7378
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD KENNETH HURLEY
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Credential | M.D.
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Telephone | 254-235-4414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | E8581
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License Number State | TX
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